This chapter discusses the history and evolution of phlebotomy from bloodletting using leeches to modern standards set by regulatory agencies. It outlines the primary roles and responsibilities of phlebotomists as obtaining blood specimens, maintaining professionalism, and ensuring safety and confidentiality. Key locations where phlebotomists work include hospitals, nursing homes, clinics, and physician's offices.

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Chapter 1

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Chapter 1 2
Introduction to Phlebotomy

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Chapter 1 3
Learning Outcomes
Upon Completion of this chapter, you should be
able to:
• Describe the evolution of
phlebotomy.
• Describe the roles and
responsibilities of the phlebotomist.
• Discuss professionalism, public
image, and customer service as they
relate to the phlebotomist

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Chapter 1 4
Learning Outcomes (cont’d)
• Identify the various settings where
phlebotomists are employed.
• List the regulating agencies for
phlebotomy.
• Identify safety and infection control
practices related to phlebotomy.
• Describe HIPAA, law, and ethics
related to phlebotomy.

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Chapter 1 5
 Phlebotomy means to cut into a vein.
 This procedure of cutting or puncturing a vein
is performed by a phlebotomist.
 The primary role of a phlebotomist is to obtain
blood specimens for testing.
 Other roles include packaging urine specimens,
accepting incoming specimens, and routing
specimens to other departments.
Introduction

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Chapter 1 6
History of Phlebotomy
History of
Phlebotomy
P
h
l
e
b
o
t
o
m
y
leeches
• Removing blood from veins dates
back to about 1400 B.C. when
leeches were applied to the skin
of sick people.
• In the early 1800’s,
medicinal leeches were
used for the procedure
known as bloodletting.
• Bloodletting was typically
performed by barbers or anyone
claiming medical training.

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Chapter 1 7
Bloodletting
• Performed by a cut
into a vein with a
sharp instrument to
drain blood
• The lancet was the
most popularly used
instrument
• Aseptic practices were
not known, so the
lancet was reused for
several patients
Then Now
• Profession emerged as a
result of technology and
expansions in laboratory
function
• Performed by trained
professionals
• Standards of practice set
by the Clinical and
Laboratory Standards
Institute (CLSI)

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Chapter 1 8
Apply your Knowledge
What is the primary role of the
phlebotomist?
ANSWERANSWER: To obtain blood specimens for
testing
BRAVO!

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Chapter 1 9
Apply Your Knowledge
The standards for the practice of
phlebotomy are set by which
organization?
ANSWER:ANSWER: Clinical and Laboratory
Standards Institute
Good Job!

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Chapter 1 10
Roles and Responsibilities of
the Phlebotomist
PATIENT IDENTIFICATION
• Check armband or ID label
in acute care settings
• Check driver’s license or
picture ID in outpatient
settings
Proper Identification Is a Three-Step Process
ASK 
COMPARE
VALIDATE


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Chapter 1 11
Roles and Responsibilities (cont’d)
Specimen Collection and Handling
Physician orders indicate type of specimen and
time of collection
Most Commonly Used Methods
Venipuncture
Insertion of a needle
into a vein to remove
blood
Dermal Puncture
Use of puncture device
to obtain capillary blood
by pricking the skin

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Chapter 1 12
Roles and Responsibilities (cont’d)
Professionalism
•Be professional
•Apply good interpersonal skills
•Dress professionally
Many institutions require
that phlebotomists wear
a lab jacket and
specified shoes to meet
OSHA guidelines.

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Chapter 1 13
Roles and Responsibilities (cont’d)
The phlebotomist must be able to
communicate using nonmedical
terms.
Verbal and nonverbal communication
should be appropriate, such as:
• Avoiding the use of slang
• Speaking in a calm, clear voice
• Avoiding inappropriate terms
• Maintaining eye contact
• Neat, well-groomed appearance
• Respecting personal space

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Roles and Responsibilities (cont’d)
When providing customer service:
• Be empathetic
• Observe the patient’s behavior
• Listen to the patient’s concerns
• Address any situation promptly
• Be flexible

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Chapter 1 15
Apply Your Knowledge
What are the two most commonly used
methods of blood specimen collection?
ANSWER: Venipuncture and dermal
puncture
Great!

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Chapter 1 16
Apply Your Knowledge
True or False: The phlebotomist must
be able to communicate using
nonmedical terminology.
ANSWER: True. The use of nonmedical
terminology is important for patient
understanding of the procedure.
Bravo!

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Chapter 1 17
Where Do Phlebotomists Work
(Inpatient)
Medical
Center
Inpatient Facilities
Phlebotomists employed at
inpatient facilities work
directly with several
members of the health care
team.
Hospitals
Nursing Homes
Rehabilitation Centers

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Chapter 1 18
Where Do Phlebotomists Work
(Outpatient)
Outpatient Facilities
Physician’s Offices
Home Health Care Agencies
Ambulatory Care Centers
Reference Laboratories
Blood Banks
Ambulatory care centers are the fastest-
growing outpatient facilities.

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Chapter 1 19
Apply Your Knowledge
Give three examples of inpatient care
facilities where phlebotomists may
work.
ANSWER: Hospitals, nursing homes, and
rehabilitation facilities
Good Job!

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Chapter 1 20
Regulatory Agencies
Clinical Laboratory
Improvement Amendment
(CLIA)
• Established in 1988 to ensure that all laboratories
receiving federal funds, regardless of size, would meet
the same standards
• As of 1992, this legislation became the main regulatory
body for all laboratories
• Establishes qualifications for phlebotomists

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Chapter 1 21
Regulatory Agencies (cont’d)
• Centers for Disease Control (CDC)
• Occupational Safety and Health Administration (OSHA)
• Clinical and Laboratory Standards Institute (CLSI)
• Healthcare Finance Administration (HCFA)
• Department of Health and Human Services (DHHS)

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Chapter 1 22
Regulatory Agencies (cont’d)
The Joint Commission on Accreditation ofThe Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) and theHealthcare Organizations (JCAHO) and the
College of American Pathologists (CAP) helpCollege of American Pathologists (CAP) help
ensure a high standard of care for patients.ensure a high standard of care for patients.
JCAHO is the main accrediting agency for
hospitals.
Laboratory classifications
are based on the complexity
of testing.
Waived
Moderately Complex
Highly Complex

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Chapter 1 23
Apply Your Knowledge
Which amendment established
qualifications for phlebotomists?
ANSWER: Clinical Laboratory
Improvement Amendment (CLIA)
GREAT!

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Chapter 1 24
Contact transmission of infectious
agents can be caused by either direct
or indirect contact.
Direct Contact
Requires transfer of
pathogens from
reservoir to a
susceptible host
(person to person)
Indirect Contact
Contaminated item is
handled prior to contact
with a susceptible host
(person to contaminated
item to person)
Safety and Infection Control

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Chapter 1 25
Safety and Infection Control (cont’d)
Prevention of Nosocomial Infections
Breaking the Chain of Infection
The Six LinksThe Six Links
Breaking the
chain of infection
at any of these
links will prevent
an infection from
developing.

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Chapter 1 26
STANDARD
PRECAUTIONS
Combines the good
hand hygiene and the
use of gloves when
workers are exposed
to contaminated
products
ISOLATION
PRECAUTIONS
Based on how the
infectious agent is
transmitted:
Airborne
Droplet
Contact
Centers for Disease Control (CDC) Levels of Protection
for the Prevention of Nosocomial Infections
Always follow Standard Precautions with every patient
when performing phlebotomy!!
Safety and Infection Control (cont’d)

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Chapter 1 27
Safety and Infection Control (cont’d)
If performed correctly, will reduce
the risk of transmitting infection
Steps to Proper
Handwashing
• Remove all rings and jewelry
• Wet hands thoroughly using
warm water
• Apply antibacterial soap and
work up a good lather
• Interlace fingers using friction
to cleanse the hands

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Chapter 1 28
Safety and Infection Control (cont’d)
Steps to Proper Handwashing Technique (cont’d)
• Use an orange stick or
handbrush to clean under
fingernails
• Be sure not to lean against
the sink area
• Rinse each hand with fingers
pointing downward
• Keep fingers pointed
downward so water and
lather will drain toward
fingertips
• Turn water off and dry
hands thoroughly with
paper towels
• Turn off water with a
clean paper towel if
needed
• Clean area of the sink
without
recontamination of
your hands if needed

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Chapter 1 29
Safety and Infection Control (cont’d)
Alcohol-based hand rub
•Make sure there is no visible dirt
or contamination.
•Apply ½ to 1 teaspoon of alcohol
cleanser to one hand. Check the
manufacturer’s directions for
proper amount.
•Rub your hands together
vigorously, making sure all
surfaces are covered.
•Continue rubbing until your hands
are dry.

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Chapter 1 30
Safety and Infection Control (cont’d)
OSHA is the federal organization responsible for
preventing or minimizing employee exposure to
bloodborne pathogens such as hepatitis and HIV.
• OSHA mandates that health care
facilities provide annual training
on preventing exposure to
bloodborne pathogens.
• OSHA requires that health care
facilities provide the necessary
Personal Protective Equipment to
prevent exposure.
Occupational Safety and Health Administration

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Chapter 1 31
Needlestick Safety and Prevention Act of 2001
• Established through the recommendation of
the National Institute for Occupational Safety
and Health (NIOSH) and the Occupational
Safety and Health Administration (OSHA)
• Mandated the use of safety devices on
needles for the prevention of exposure to
bloodborne pathogens
• All devices for phlebotomy should be
equipped with needlestick prevention features
Safety and Infection Control (cont’d)

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Chapter 1 32
Apply Your Knowledge
Name the two levels of protection developed by
the CDC for the prevention of nosocomial
infections.
ANSWER: Standard and Isolation
Precautions
GREAT!

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Chapter 1 33
Apply Your Knowledge
Which agency has the responsibility
of minimizing or preventing exposure
to bloodborne pathogens?
ANSWER: Occupational Safety and
Health Administration (OSHA)
GOOD JOB!

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Chapter 1 34
Health Insurance Portability and Accountability Act
(HIPAA)
•Developed in response to medical information
transactions
•In 2003, established a national standard for
electronic health care transactions
•Protects the privacy and confidentiality of patient
information
•Patient information can be shared only for
treatment purposes
HIPAA, Ethics, and Law

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Chapter 1 35
HIPAA – Protect Patient Information!
• Close patients’ room
doors when
discussing their health
• Do not talk about
patients in public
places
• Log off computers
when finished
• Turn computer
screens so
passersby cannot
see patient
information
• Do not walk away
from patient medical
records; close them
when leaving
HIPAA, Ethics, and Law (cont’d)

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Chapter 1 36
HIPAA, Ethics, and Law (cont’d)
Code of Ethics
Ethics consist of a set of written rules, procedures,
or guidelines that aid in determining right from
wrong.
Remember the Golden Rule!!!
Treat others the way you would want
to be treated.
All Information Concerning a Patient’s
Care Must Remain Confidential!

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Chapter 1 37
HIPAA, Ethics, and Law (cont’d)
A phlebotomist must have clear consent from the patient
before performing any blood collection procedure!
Patients have the right to:
• Refuse care
• Be treated with respect
• Have all records and information kept confidential
• Be informed about the purpose and expected results of
treatments
• Have access to their medical records

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Chapter 1 38
Apply Your Knowledge
What act was established in 2003 to
protect the privacy and
confidentiality of patient
information?
ANSWER: Health Insurance
Portability and Accountability Act
(HIPAA) BRAVO!

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Chapter 1 39
Apply Your Knowledge
A patient’s right to refuse care, be treated
with respect, have all records kept
confidential, and be informed regarding the
purpose and outcome of treatment is
known as:
ANSWER: The Patient’s Bill of Rights
GREAT!

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Chapter 1 40
CHAPTER 1 SUMMARY
 The art of phlebotomy has evolved from the use of
leeches to modern-day certified phlebotomists.
 Phlebotomists are responsible for collecting,
processing, and transporting blood specimens.
 Professionalism involves a positive attitude and
appearance, proper communication to the patient,
and providing quality customer service.
 Phlebotomists are employed at hospitals,
rehabilitation centers, nursing homes, clinics,
physician’s offices, ambulatory care centers, blood
banks, and reference labs.

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Chapter 1 41
CHAPTER 1 SUMMARY (cont’d)
 There are many regulating agencies for phlebotomy
including CLSI, JCAHO, HCFA, CDC and OSHA.
 Infection control and safety practices include hand
hygiene and Standard and Isolation Precautions.
 HIPAA provides protection of health care information.
Ethics is used to help determine right from wrong.
The law includes following your scope of practice and
obtaining consent for procedures.

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END OF CHAPTER 1
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than any one thing.
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